Treating Social Determinants Of Health Can Help End HIV/AIDS

Picture this scenario: An individual living with HIV in British Columbia, "Doug" (whose name has been changed for privacy), was being "shuffled around" through care. As a result, he had grown tired and had mostly given up on treating his HIV. Sadly, he had begun telling family and friends that he wouldn't be around much longer. Can you see a solution to a situation like this?

There was an answer for Doug. An outreach worker, with the province of B.C.'s STOP® Program (Seek and Treat for Optimal Prevention of HIV/AIDS), knocked on his door and started to connect him to services to help support his medical adherence.

Doug needed to have a regular health care provider, and the outreach worker set him up with one. Beyond that, he needed the supports to help him stay consistent with care. He was placed in supportive housing, as well as in an integrative care program where he could develop his interests in music. Eventually, Doug (an electrician by trade who plays and builds musical instruments) became healthy, fully adherent to HIV medications and achieved an undetectable viral load.

In Canada, it's time to be a national leader on ending AIDS globally.

Stories like Doug's are very personal and individual victories; however, they show the changes that can take place when addressing systemic social and economic barriers. B.C.'s STOP® Program, based on principles of the Treatment as Prevention® (TasP) strategy developed at the B.C. Centre for Excellence in HIV/AIDS (BC-CfE), acknowledges the importance of addressing social and economic inequities -- termed social determinants of health. The STOP® Program aims to expand and offer access to HIV testing, care and treatment for medically eligible B.C. residents, particularly for populations experiencing difficulties in accessing traditional services.

The concept behind STOP® is to immediately offer universal HIV treatment to those diagnosed with the disease. This TasP® approach has led to improved health outcomes and to a consistent drop in new HIV cases in B.C.. Once on sustained and consistent treatment, an individual's viral load declines making it highly unlikely they will transmit the virus. B.C. is the only province to implement TasP® and the only one to see a consistent drop in new HIV cases. Globally, the United Nations has adopted a plan to end AIDS by 2030 that is based on principles of TasP®. Organizations like the Global Fund are on board with this plan to #EndItForGood and make the next generation AIDS-free.

In B.C., through TasP® and STOP® we have seen successes like Doug's. We have seen people living with HIV who use injection drugs, a population some doubted could maintain consistent treatment, achieve improved health and see significant reductions in HIV transmission. (In B.C., through consistent access to HIV treatment, the number of people who inject drugs who achieved an undetectable viral load increased from 30 per cent in 2006 to 71 per cent in 2012.)

How does the STOP® program work? It all starts with using resources to build more pathways to care and treatment. Even in a largely resource-rich nation like Canada, mental health, addiction, homelessness and poverty can present obstacles to this goal.

Across the province, members of multi-disciplinary, collaborative outreach teams under the STOP® program -- which can include nurses, outreach workers, social workers and others -- serve the most vulnerable populations. Clients may have suffered trauma and lack trust in traditional health care systems. For example, people who inject drugs and sex workers may feel stigmatized or discriminated against within the health care setting.

Many clients are confronting an intersection of challenges: They may simultaneously be facing addiction and homelessness problems, while dealing with access to HIV treatment and care. Individuals living with HIV may also have mental health disorders, like depression or anxiety, leaving them unable to take the steps towards self-care. According to previous research, individuals living with HIV are two to ten times more likely to have at least one mental health condition, in comparison to the general population.

Despite such challenges, the STOP® program, conducted through B.C.'s health authorities has made headway in the fight against HIV/AIDS: After initial success as a pilot program in Vancouver and Prince George, STOP® was expanded provincially along with a $19.9 million investment from the provincial government. In September, Northern Health, a B.C. health authority providing health services to 300,000 people over an area of 600,000 square kilometers, awarded $1.59 million to eight agencies and 23 First Nations communities as part of the provincial STOP® initiative.

Success stories from STOP® show how effectively addressing underlying social, economic or other needs can lead to improved HIV treatment outcomes. Sometimes it takes a caring visit, a knock on the door. Sometimes it takes repeated visits, food vouchers, or access to housing.

Globally, the Canadian government has endorsed the UN's plan to end AIDS by 2030. This year, Prime Minister Justin Trudeau boosted Canada's pledge to the Global Fund by 20 per cent, in a commitment to globally end AIDS, TB and Malaria for good. The BC-CfE is proud the Canadian federal government has made such commitments. It is important to invest in change so that barriers to care can be even across resource-limited settings.

In Canada, it's time to be a national leader on ending AIDS globally. We have the tools and strategies to provide treatment to all those living with HIV -- the province of B.C. has the successes to prove it. A nationwide Treatment as Prevention is a way forward, and we must continue to open doors to care and treatment for society's most vulnerable. Together, we can stop HIV/AIDS.

This blog is part of the blog series: AIDS, TB and Malaria: It's High Time for Us to End It. For Good by the Interagency Coalition on AIDS and Development (ICAD) in recognition of The Global Fund's Fifth Replenishment. The blog series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on the work of The Global Fund and the opportunity that this moment presents us one year following the inauguration of the global Sustainable Development Goals (SDGs).

Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.

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10 Important HIV/AIDS Discoveries

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Only one quarter of the 1.1 million people with HIV have their condition under control, where "under control" means the virus has been suppressed, according to a report released this summer by the Centers for Disease Control and Prevention.
CORRECTION: The first sentence has been reworded to more accurately reflect the number of people with HIV.

Even though two men were, for a time, able to go off antiretrovirals because their HIV had been reduced to undetectable levels after receiving bone marrow transplants, the HIV eventually returned in the men, according to news reports.
In 2012, the news of the men’s undetectable HIV levels made headlines. The men, who were both HIV positive and taking antiretroviral drugs, had received bone marrow transplants for Hodgkin’s lymphoma. They had received the transplants while they were also taking the antiretroviral medication.
However, in late 2013, preliminary results showed that the HIV had returned.
This slide has been updated to note more recent developments related to the procedure.

New HIV infection rates can be dramatically lowered by making antiretroviral drugs free, a study from Canadian researchers found.
The Canadian Press reported on the study, conducted by B.C. Centre for Excellence in HIV-AIDS researchers, which showed that British Columbia -- a province that offers free access to antiretroviral therapy -- had the lowest rate of new HIV infections over a more-than-10-year period, compared with Ontairio and Quebec.

More than half of HIV-infected young people are unaware that they have the virus, according to a Centers for Disease Control and Prevention report.
"Given everything we know about HIV and how to prevent it in 30 years of fighting the disease, it's just unacceptable that young people are becoming infected at such high rates," Reuters reported CDC Director Dr. Thomas Frieden saying.
The report also showed that for young people, 72 percent of the new HIV infections were in men who have sex with men, while almost 50 percent were in young, African-American males, Reuters reported. These figures are based on 2010 data.

The number of people living with HIV has increased by 18 percent from 2001 to 2011, according to a report released this year from the United Nations Programme on AIDS. An estimated 34.2 million people around the world are living with HIV.
The report also showed that deaths from AIDS have dropped, from 2.3 million in 2005-2006 to 1.7 million in 2011, Reuters reported.

According to the same United Nations report, costs for the cheapest UN-recommended antiretroviral therapy drugs have also decreased over the past 10 years, Reuters reported. A year's worth of the drugs used to cost $10,000 in 2000 for one person; now, it costs $100 a year.

The Food and Drug Administration this year officially approved the drug Truvada -- which has been used since 2004 as a treatment for HIV -- to be sold as a preventive measure for people who don't have the infection, but are at high risk for it.
The FDA said that the pill should be considered for preventive use not only by gay or bisexual men who are at high risk for HIV, but also heterosexual men and women who may also face HIV risks, the Associated Press reported.
Heterosexual men and women make up more than one-fourth of new cases of HIV, and "that's not a portion of the epidemic we want to ignore," the CDC's Dr. Dawn Smith, who was the lead author of the new recommendations, told the Associated Press.
The FDA also approved a new drug this year, Stribild, to treat HIV, Reuters reported.

In findings published this year in the journal PLoS Pathogens, scientists from the University of California, Los Angeles found that it's possible to genetically engineer stem cells to attack living HIV-infected cells in mice.
While the study was only for "proof-of-principle," it "lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body," study researcher Dr. Scott G. Kitchen, an assistant professor of medicine at UCLA, said in a statement.

People should be screened for HIV even if they're not at high risk of contracting the infection, according to draft recommendations released just last month by the U.S. Preventive Services Task Force. The recommendations would mean that everyone between the ages of 15 and 65 should be screened for HIV, even if they're not at high risk for it, Reuters reported.
"The prior recommendations were for screening high-risk adults and adolescents," Dr. Douglas Owens, a member of the USPSTF task force and a Stanford University medical professor, told Reuters. "The current recommendation is for screening everyone, regardless of their risk."

All HIV patients should be treated immediately with antiretrovirals, according to new guidelines issued this year from a panel of the International Antiviral Society-USA, as reported by TIME. The recommendations are counter to previous guidelines, which said that antiretrovirals should only be used if the CD4 count -- a measure of immune cells in a person's body -- becomes less than 350 cells for every mm3 of blood.